Healthy systems:

Laalitha is focused on making an impact, and as you’ll see in the interview below, she thinks about change in terms of the systems that contribute to our health. She also sheds light on the complexity of being just one small person working to transform big problems. She answers key questions like “How do you make sense of your eco-anxiety?” and “Where did you start when you decided to take action?”

Ultimately, Laalitha’s story provides a framework for balancing the sense powerlessness we feel about “fixing everything” with the power we each hold to make things better for the people around us – especially those on the frontlines of climate impacts. -RMC

RMC: Tell us a bit about yourself. What informs your thinking about the climate crisis?

LS: I’m Laalitha Surapaneni, I’m an Internal Medicine physician at the University of Minnesota.

I grew up in India and I came here to the U.S. for my Public Health degree. Outside of the hospital, I do a lot of climate advocacy work, because I believe we need to change systems to make our behaviours more green and healthy.

RMC: How did you start making the connections between health and climate change?

LS: Our impact on the environment, and how that then affects us, was an ever-present theme growing up. I’ve always been an environmentalist at heart. But one of the main things that always bothered me was that some people suffer the impacts of climate and environmental disasters more than others. As I was going through my medical training, I learned a lot more of the science behind all of these things that I had picked up growing up as a child, and figured out more about the connections between environments and how they impact our health. So it’s always been there.

RMC: What does eco-anxiety mean to you? Do you relate to feeling “eco-anxious”? How would you nuance that term given your experience?

LS: I think what that term means to me has evolved, certainly, over the course of the last several years. When I finally realized the enormity of the challenge that faces us, and the level of inaction that there is, that was very anxiety-provoking. It was also something that as a person, I felt disempowered by. What can one person do when the challenge that faces us is so big? It also then took me to a place of despair. I thought “Well, if I can’t fix everything and make everything perfect, why bother?” That was a dark space that I had to work my way out of.

“That helped me change my thinking and make the most of my skillset and the time that I have.”

That’s where the environmental justice piece really helped me. When we often talk about the past as a “pristine earth” before environmental destruction and species extinction, or we talk about the future, and how we only have a short amount of time before “the world ends”. But if you think about it in justice terms, people are being impacted today. The world is ending for someone today. So no matter what you’re able to impact, no matter what you’re able to bring about, it’s going to help someone, and it’s going to help the most vulnerable people. That helped me change my thinking and make the most of my skillset and the time that I have.

A justice lens on climate vulnerability

RMC: I’d love to hear more, from your professional perspective, on how the environment determines our health. What is your framework for analysing people’s health and their environment? How does it connect to systems?

LS: I use a vulnerability assessment framework. The three things involved are exposure, sensitivity, and adaptive capacity.

For exposure, we might ask “Are you living in an area where there is high air pollution?” or “Are you a laborer who has to work long hours in extremely hot weather?” These are things that determine our exposure. Climate justice plays a role here, because we do know that fossil fuel infrastructure is placed in communities of colour and Indigenous communities. We know that there aren’t enough laws to protect workers from heat-related stress.

“No matter what change you’re able to bring about, it’s going to help someone, and it’s going to help the most vulnerable people.”

Exposure and Sensitivity

Sensitivity is not something we can really change a whole lot, because that usually has to do with your age, or pre-existing conditions that amplify climate impacts. So how do you combat exposure and sensitivity? With adaptive capacity.

We want to improve adaptive capacity through policy, so that we can create systems that protect the health of the most vulnerable. Physicians like me, and other health professionals, can play a role in coming up with policies that protect health. You could speak up about heat stress. You could advocate for more electric and active transportation systems to reduce air pollution. You could call for better access to health care – that’s a huge piece for adaptive capacity. We can build systems that reduce exposure and improve adaptive capacity, and promote better health for all.

RMC: So instead of getting anxious about my personal exposures, my personal sensitivities, and my personal adaptive capacities – which will only get me so far in a climate crisis – there’s a need for whole systems built upon this framework?

LS: Yes, I mean just look at COVID, we’re seeing that people who have more sensitivity, that is, weaker immune systems, that impacts certain populations more than others like elderly people or people with compromised immune systems. But then we can also look at exposure. If you have a job without paid sick days, or if you live in poverty, you might not be able to take time off. Exposure is wider in communities with these characteristics. Professionals in healthcare and education are also facing higher exposure. If we have really strong public health systems, we can provide guidance and support to limit exposure. Adaptive capacity asks “Is there adequate testing?” “Is it free?” “Are public health messages being communicated?” “Is there access to a vaccine?” “Is it free?”. These are key systems-level pieces that go beyond personal behaviours.

Part of a bigger story

RMC: How do you make sense of your role in a story that is so much bigger than yourself?

LS: Personally, I’m drawn to changing public policy. That may not appeal to everybody, but you can think of your own “spheres of influence”. Picture a Russian nesting doll. The individual level as the smallest piece, and then around that are the institutions that you’re a part of, and around that is public policy. The theory is that as your spheres get bigger, the wider your influence.

“It goes a long way when you make the “green choice” or the “healthy choice” the easiest, most default option.”

But it’s also about reaching out to other individuals in your spheres and impacting how they view their own spheres. We can start with our shared concerns and our collective influence. I focus on systems because I know that, just like with health, it goes a long way when you make the “green choice” or the “healthy choice” the easiest, most default option. That’s what gets me the most excited, and that’s why I focus on systems and policy.

RMC: What message would you have for those who are still feeling alone, struggling to connect the dots between their individual power and these big systems-level problems? How did you start making that connection meaningful?

“Why would anyone listen to me? I’m just a doctor.”

LS: I remember those moments of despair, and when you realize the enormity, it’s so easy to say “I didn’t create this problem by myself. I’m not going to be able to solve this problem by myself. So why engage?” Or even if you engage, you don’t see the immediate response at the systemic level. Understanding your place in the movement is important. Even though the links between public health and climate are more apparent, it was difficult at first to make those connections. I kept thinking “Why would anyone listen to me? I’m just a doctor. I’m not a policy expert. I don’t control any fossil fuel companies.”

To get to where I am now, where I’m advocating for climate policies to protect health, that started with me getting connected with groups who were already working on climate and health policy. I went to a community in Baltimore that was working on shutting down an incinerator. They had one of the highest asthma rates. Just going to that table and asking how my training, expertise, or just me as a person, could help them, that was really how I found my path toward using my role, my power, and my privilege, to affect change. I started by going to the grassroots, the frontlines, to the people who are being impacted by this the most.

The second big thing was finding community. I had to find other physicians and health professionals who were interested in doing this work to learn and find mentors. What I’ve learned along the way though is that climate change impacts everything. We know this. So that means we need people with all types of expertise involved in this struggle to create solutions. It’s not just health professionals, it’s not just policy-makers. No matter what expertise you have, it will be useful, and it can help us create solutions that work for all. You don’t need to get a new degree, you just need to ask “What is my expertise? Where do I fit in?”.

“I’ve begun to understand that despair comes out of a place of privilege.”

We keep going

RMC: There’s something fundamental there that you demonstrate with your story, which is that if you don’t know how you can be helpful, you can just ask. You can just say “Hey, I’m a doctor, how can I help you?” Knowing that we can’t solve it on our own prompts so many of us to just stop trying. But it’s really an invitation to connect. If you can’t do it alone, team up! There’s a role that fits with who you already are, not who you are after you’ve gained expertise, or who you are after you become a better person. It’s more about “when” you are then “who” you are.

LS: Definitely. I read on Twitter recently that “Despair doesn’t sequester carbon” and that’s been my go-to phrase when I get lost in feeling powerless. I’ve begun to understand that despair comes out of a place of privilege. You’re able to sit back and say there’s no point and then walk away from this. Whereas people who are actually suffering the impacts don’t get that choice.

Grief is a different thing from despair. We all feel the loss, and we should grieve the loss of ecosystems, the loss of species. But I don’t think we should let it get to a place of helplessness. As a health professional, I see this in my daily life. I’ve told people “You’ve smoked for 40 years and now you’ve lost half your lung capacity. But life doesn’t stop here”. No one says “Well, if I can’t go back in time, then I guess I’ll give up.” Nobody says that.

Instead we work on preserving what we already have, and creating the best possible quality of life. People show so much incredible bravery and courage in the face of life-threatening illnesses, and we keep going. And that’s kind of what I try to then extrapolate to the planetary situation as well. How do we preserve and protect what we have and how can we improve?

(For more from Laalitha, follow her on Twitter @LaaliMD)